Q01
Message
All templatesPrivacy & Compliance
Lash Extension Client Health & Consent Screening
A pre-appointment health-screening and informed-consent form for lash extension clients that captures allergy history, current medications, contact lens use, and aftercare understanding, plus a signed consent record. An AI follow-up interview clarifies any health disclosures or unclear aftercare answers before the technician proceeds, so studios document genuinely informed consent, not just a checked box.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
ConsentRequired
Please read the following before continuing.
Q03
Multiple ChoiceRequired
Do any of the following apply to you?
- Known allergy to latex or adhesives
- Sensitive or easily irritated skin around the eyes
- Eye allergies (seasonal or chronic)
- Recent eye surgery or eye infection (within 6 months)
- Currently pregnant or breastfeeding
Q04
Multiple ChoiceRequired
Have you ever had a reaction to lash extensions, lash glue, or eye makeup products?
- Never had lash extensions before
- Yes, I had a reaction
- No, never reacted
- Not sure
Q05
Long Text
Please list any medications, eye drops, or supplements you currently use that could affect your eyes or skin (for example, Latisse, retinoids, blood thinners). Type 'None' if this doesn't apply.
Q06
Multiple ChoiceRequired
Do you currently wear contact lenses?
- Yes, daily
- Yes, occasionally
- No
Q07
Opinion ScaleRequired
How clear is your understanding of the aftercare instructions (cleaning, avoiding oil-based products, refill timing)?
Scale: 1 – 5
Min:Not clear at allMax:Completely clear
Q08
Text Highlight
Please highlight any part of these aftercare instructions you'd like your technician to explain further.
Avoid getting your lash extensions wet or steamy for the first 24 to 48 hours. Cleanse them daily with an oil-free lash cleanser. Avoid oil-based makeup removers, mascara, and eyelash curlers. Do not…
Q09
AI Interview
If the client disclosed any allergy, sensitivity, prior reaction, medication, or contact lens use, probe for specifics: severity, how long ago, and whether a doctor or previous technician advised against or modified lash services for them. If their aftercare understanding rating was 3 or below, walk through the specific instruction they're unsure about (cleaning routine, product restrictions, or refill timing) until they can restate it in their own words. Flag clearly in your summary if anything disclosed suggests the service should be postponed or modified.
Q10
Signature
Please sign below to confirm the health information you provided is accurate and that you consent to receiving lash extension services today.
Q11
Message
One last optional question, then you're all set.
Q12
Multiple Choice
What is your age range? (Optional — helps us track service safety trends across age groups.)
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q13
Message
Thank you! Your consent and health information will be kept on file with your appointment record and shared only with your technician to help them provide safe, personalized service.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Goes beyond a signature by having an AI follow-up interview clarify any allergy, sensitivity, prior reaction, medication, or contact lens disclosure before the technician proceeds
- Includes a text-highlight step so clients can flag exactly which aftercare instructions they're unsure about, not just a generic checkbox
- Uses an opinion scale to measure the client's actual understanding of aftercare (cleaning, avoiding water/oil, etc.) rather than assuming comprehension
- Pairs the signed consent record with automated quality scoring and an auto-generated report, so studios have documentation of genuinely informed consent, not just a checked box
Jotform
Eyelash Extension Consent Form TemplateA static, fielding-ready consent form built specifically for lash extension studios. It likely covers standard fields like allergy history and a signature, and can be customized via Jotform's form builder. There's no mechanism to follow up on unclear or concerning answers before the appointment.
What it does well
- Purpose-built for lash extension studios
- Easy drag-and-drop customization typical of Jotform templates
- Likely supports e-signature collection out of the box
Where it falls short
- Static form with no adaptive follow-up on health disclosures or unclear aftercare answers
- No automated quality scoring of responses
- No transparent, reviewable AI prompt methodology since there's no AI interview step
SurveyMonkey
Lash Extension Consent Form TemplateA ready-to-use lash extension consent template on a well-known survey platform, likely offering quick deployment and basic response collection. It's a standard questionnaire format rather than an interview, so any ambiguous or concerning disclosure would need manual follow-up by staff. Reporting is likely limited to raw response summaries.
What it does well
- Backed by SurveyMonkey's established survey distribution and analytics tools
- Quick to deploy for studios already using SurveyMonkey
- Template is specifically labeled for lash extension consent
Where it falls short
- No adaptive AI interview to clarify allergy, medication, or aftercare-understanding answers
- No voice AI interview or guided screen-share task option
- No automated per-response quality scoring
Typeform
Eyelash Extension Consent Form TemplateA conversational-style form template suited to Typeform's one-question-at-a-time UX, which likely makes it more approachable for clients than a dense paper form. It remains a fixed sequence of questions, however, with no ability to probe deeper when a client discloses a reaction or unclear understanding. No mention of built-in interview or scoring capability.
What it does well
- Polished, conversational question flow typical of Typeform
- Likely mobile-friendly and quick for clients to complete
- Specifically templated for eyelash extension consent
Where it falls short
- Fixed question sequence with no adaptive AI follow-up on flagged health disclosures
- No option for a voice AI interview component
- No automated quality scoring or auto-generated consent report
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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